TITLE 24

Professions and Occupations

CHAPTER 19. NURSING

§ 1901 Declaration of legislative intent.

The General Assembly hereby declares the practice of nursing by competent persons is necessary for the protection of the public health, safety and welfare and further finds that the levels of practice within the profession of nursing should be regulated and controlled in the public interest. In order to safeguard life and health, the general administration and supervision of the education, examination, licensing and regulation of professional and practical nursing is declared essential, and such general administration and supervision is vested in the Board of Nursing.

(a) "Administration of medications" means a process whereby a single dose of a prescribed drug or biological is given to a patient by an authorized licensed person by 1 of several routes, oral, inhalation, topical, or parenteral. The person verifies the properly prescribed drug order, removes the individual dose from a previously dispensed, properly labeled container (including a unit dose container), assesses the patient's status to assure that the drug is given as prescribed to the patient for whom it is prescribed and that there are no known contraindications to the use of the drug or the dosage that has been prescribed, gives the individual dose to the proper patient, records the time and dose given, and assesses the patient following the administration of medication for possible untoward side effects.

(b) [Repealed.]

(c) "Advanced practice registered nurse" ("APRN") means an individual with knowledge and skills acquired in basic nursing education; licensure as a registered nurse ("RN"); and graduation from or completion of a graduate-level APRN program accredited by a national accrediting body and current certification by a national certifying body in the appropriate APRN role and at least 1 population focus. "Advanced practice registered nurse" includes certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, or clinical nurse specialists. Advanced practice nursing means an expanded scope of nursing in a role and population focus approved by the Board of Nursing, with or without compensation or personal profit, and includes the RN scope of practice. The scope of an APRN includes performing acts of advanced assessment, diagnosing, prescribing, and ordering. Advanced practice nursing is the application of nursing principles, including those described in subsection (y) of this section.

(d) "Collaborative agreement" means a written document expressing an arrangement between a licensed physician, podiatrist, or licensed Delaware health-care delivery system and an advanced practice registered nurse.

(e) "Compact Administrator" means the Executive Director of the Delaware Board of Nursing who is designated as the Compact Administrator under Chapter 19A of this title by the President of the Board.

(f) "Consultation" means the communication and decision-making process among health-care professionals related to the treatment and care of a patient, including the exchange of clinical observations and assessments; accessing and assessment of appropriate additional resources or expertise; arrangement of appropriate referrals, testing, or studies; and development of an appropriate plan of care that includes decisions regarding the health care provided.

(g) "Dispensing" means providing medication according to an order of a practitioner duly licensed to prescribe medication. The term includes both the repackaging and labeling of medications from bulk to individual dosages.

(h) "Distant site" means a site at which a health-care provider legally allowed to practice in the State is located while providing health-care services by means of telemedicine or telehealth.

(i) "Full-practice authority," as granted to an advanced practice registered nurse, means all of the following:

(1) Practicing within standards established or recognized by the Board of Nursing.

(2) Being accountable to patients, the nursing profession, and the Board of Nursing for complying with the requirements of this chapter and the quality of advanced nursing care rendered.

(3) Recognizing limits of knowledge and experience.

(4) Planning for the management of situations beyond the APRN's expertise.

(5) Consultation with or referring patients to other health-care providers as appropriate.

(j) "Head of the Nursing Licensing Board" means the President of the Delaware Board of Nursing.

(k) "Independent practice" means practice and prescribing by an advanced practice registered nurse who is not subject to a collaborative agreement and works outside the employment of an established health-care organization, health-care delivery system, physician, podiatrist, or practice group owned by a physician or podiatrist. Independent practice be in an area substantially related to the population focus of the APRN's education and certification.

(l ) "Licensure" means the authorization to practice nursing within this State granted by the Delaware Board of Nursing and includes the authorization to practice in Delaware under the Interstate Nurse Licensure Compact [Chapter 19A of this title].

(m) "Limited lay administration of medications (LLAM)" means a process by which LLAM trained unlicensed assistive personnel, functioning in a setting authorized by § 1932 of this title, give a prescribed medication to clients, patients, residents, or students as ordered by a licensed practitioner authorized to prescribe medications or gives a nonprescription medication pursuant to the Delacare regulations.

(n) "LLAM trained unlicensed assistive personnel (UAP)" means an individual who has successfully completed the Board of Nursing approved LLAM course, including the core course and any program specific specialized training modules required.

(o) "Nurse educator" means a registered nurse who is a faculty member or director of a Delaware board-approved nursing education program preparing individuals at the registered nurse entry level.

(p) "Nursing diagnosis" means the description of the individual's actual or potential health needs which are identified through a nursing assessment and are amenable to nursing intervention. The focus of the nursing diagnosis is on the individual's response to illness or other factors that may adversely affect the attainment or maintenance of wellness. These diagnostic acts are distinct from medical, osteopathic, and dental diagnosis.

(q) "Nursing education program" means a course of instruction offered and conducted to prepare persons for licensure as a registered or licensed practical nurse, or a course of instruction offered and conducted to increase the knowledge and skills of the nurse and leads to an academic degree in nursing, or refresher courses in nursing.

(r) "Originating site" means a site in Delaware at which a patient is located at the time health-care services are provided to the patient by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used; provided, however, notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

(s) "Standards of nursing practice" means those standards of practice adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards of nursing practice may not be used to directly or indirectly affect the employment practices and deployment of personnel by duly licensed or accredited hospitals and other duly licensed or accredited health-care facilities and organizations. In addition, such standards may not be assumed the only evidence in civil malpractice litigation, nor may they be given a different weight than any other evidence.

(t) "Store and forward transfer" means the transmission of a patient's medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.

(u) "Substantially related" means the nature of the criminal conduct, for which the person was convicted, has a direct bearing on the fitness or ability to perform 1 or more of the duties or responsibilities necessarily related to the practice of nursing.

(v) "Telehealth" means the use of information and communications technologies consisting of telephones, remote patient monitoring devices, or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

(w) "Telemedicine" means the delivery of clinical health-care services by means of real time 2-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health-care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care by a licensee practicing within his or her scope of practice as would be practiced in-person with a patient and with other restrictions as defined in regulation.

(x) "The practice of practical nursing" as a licensed practical nurse means the performance for compensation of nursing services by a person who holds a valid license pursuant to the terms of this chapter and who bears accountability for nursing practices which require basic knowledge of physical, social, and nursing sciences. These services, at the direction of a registered nurse or a person licensed to practice medicine, surgery, or dentistry, include:

(1) Observation;

(2) Assessment;

(3) Planning and giving of nursing care to the ill, injured and infirm;

(4) The maintenance of health and well-being;

(5) The administration of medications and treatments prescribed by a licensed physician, dentist, podiatrist, or advanced practice registered nurse; and

(7) Dispensing activities only as permitted in the Board's Rules and Regulations. Nothing contained in this chapter shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications, or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry; and

(8) The use of telemedicine, as defined in this chapter, and practice of and participation in telehealth as further defined in regulation.

(y) "The practice of professional nursing" as a registered nurse means the performance of professional nursing services by a person who holds a valid license pursuant to the terms of this chapter, and who bears primary responsibility and accountability for nursing practices based on specialized knowledge, judgment, and skill derived from the principles of biological, physical, and behavioral sciences. The registered nurse practices in the profession of nursing by the performance of activities, among which are:

(8) The use of telemedicine, as defined in this chapter, and participation in telehealth, as further defined in regulation.

(9) Nothing contained in this chapter shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications, or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry.

A registered nurse shall have the authority, as part of the practice of professional nursing, to make a pronouncement of death; provided, however, that this provision shall only apply to attending nurses caring for terminally ill patients or patients who have "do not resuscitate" orders in the home or place of residence of the deceased as a part of a hospice program or a certified home health-care agency program; in a skilled nursing facility; in a residential community associated with a skilled nursing facility; any licensed assisted living community; in an extended care facility; or in a hospice; and provided that the attending physician of record has agreed in writing to permit the attending registered nurse to make a pronouncement of death in that case.

(z) "The profession of nursing" is an art and process based on a scientific body of knowledge. The practitioner of nursing assists patients in the maintenance of health; the management of illness, injury, or infirmity; or the achievement of a dignified death.

(a) The Delaware Board of Nursing (hereafter referred to as the Board) shall consist of 15 members. The term of office of every member appointed to the Board, except those appointed to fill vacancies occurring during any term of office, is 3 years. The Board shall be composed of 5 registered nurses, 1 licensed practical nurse, 1 nurse at-large which shall be either a registered nurse or licensed practical nurse, 2 advanced practice registered nurses representing different practice roles, 1 registered nurse educator, and 5 public members.

Registered nurse appointees shall have a diploma or an earned degree in nursing, nursing education or education, and at least 3 years active practice as a registered nurse in nursing service, administration or teaching.

Each practical nurse appointee shall be a licensed practical nurse, who is a graduate of an approved school of practical nursing, with at least 3 years active practice as a practical nurse.

The public members shall be residents of Delaware for a minimum of 3 years, shall be knowledgeable about the health needs of Delaware, but shall not be licensees of any health occupation board, employees of a health-care occupational board, employees of a health-care facility or agency, or engaged in governance or administration of a health-care facility or agency.

(b) The nursing experience referred to in this section shall have been within the last 5 years preceding appointment and said appointee must be currently licensed in Delaware.

(c) The Governor shall appoint all members to the Board of Nursing.

(d) Sixty days prior to the expiration of the term of any member of the Board, a successor shall be appointed by the Governor. A list of at least 3 nominees for each registered nurse vacancy may be furnished to the Governor by the Delaware Nurses' Association and other professional organizations in order to aid the Governor in the appointment of new members of the Board. A list of at least 3 nominees for each licensed practical nurse vacancy may be furnished to the Governor by the Delaware Licensed Practical Nurses' Association and others in the practical nursing community in order to aid the Governor in the appointment of new members of the Board. The Governor shall not be limited to the recommendations of the professional organizations in making appointments of registered or practical nurses to the Board. The Governor shall seek nominees from the consumer population for the public members appointees. Vacancies occurring for any cause other than expiration of term shall be filled by the Governor for the unexpired term as provided in this subsection.

(e) At least 1 of the professional nurse members of the Board shall be a resident of New Castle County, 1 a resident of Kent County and 1 a resident of Sussex County. Licensed practical nurse members shall be representatives of at least 2 counties simultaneously. If there is no qualified person available in the geographical subdivision, then appointments shall be made from qualified persons available in any of the other geographical subdivisions.

(f) Each member shall serve for a term of 3 years, and may successively serve for 1 additional term; provided, however, that where a member was initially appointed to fill a vacancy, such member may successively serve for only 1 additional full term. Any person appointed to fill a vacancy on the Board shall hold office for the remainder of the unexpired term of the former member.

(g) A person who has never served on the Board may be appointed to the Board 2 consecutive times, but no such person shall thereafter be eligible for 2 consecutive appointments. No person who has been twice appointed to the Board, or who has served on the Board for 6 years within any 9-year period, shall again be appointed to the Board until an interim period of at least 1 term has expired since such person last served.

(h) Any act or vote by a person appointed in violation of subsection (g) of this section shall be invalid. An amendment or revision of this chapter is not sufficient cause for any appointment or attempted appointment in violation of subsection (g) of this section, unless such amendment or revision amends this section to permit such an appointment.

(i) A member of the Board shall be suspended or removed by the Governor for misfeasance, nonfeasance or malfeasance. A member subject to disciplinary proceedings shall be disqualified from Board business until the charge is adjudicated or the matter is otherwise concluded. A Board member may appeal any suspension or removal to the Superior Court.

(j) No member of the Board shall hold any elective office in, nor be a representative of, any local, state, regional or national nursing association.

(k) The provisions set forth for "employees" in Chapter 58 of Title 29 shall apply to all members of the Board, and to all agents appointed or otherwise employed by the Board.

(a) The Board shall elect, annually, from its members a President and Vice-President. In the event of a vacancy in 1 of the offices, a replacement shall be elected at the next Board meeting or at a meeting called for that purpose.

(b) Eight members of the Board, including 1 officer, shall constitute a quorum.

(c) The Board may adopt and promulgate such rules and regulations as may be necessary to govern its proceedings, to define the duties of its officers and to effectuate the intent and purpose of this chapter.

(d) Each member of the Board shall be reimbursed for all expenses involved in each meeting, including travel, and in addition shall receive compensation per meeting attended in an amount determined by the Division in accordance with Del. Const. art. III, § 9.

(e) The Board shall adopt a seal and may use that seal on official documents.

The Executive Director shall be a registered nurse with at least 5 years' experience in an administrative or teaching position, have earned a master's degree in nursing, nursing education, education or a related health field.

(1) Adopt and, from time to time, revise such rules and regulations and standards not inconsistent with the law as may be necessary to enable it to carry into effect this chapter;

(2) Approve curricula and develop criteria and standards for evaluating educational programs preparing persons for license under this chapter;

(3) Provide for surveys of such programs at such times as it may deem necessary;

(4) Approve such programs as meet the requirements of this chapter and of the Board;

(5) Deny or withdraw approval from educational programs for failure to meet approved curricula or other criteria;

(6) Examine, license and renew licenses of duly qualified applicants, including applicants for conducting nursing educational programs and shall also prescribe the procedures for subsequent examinations of applicants who fail an examination;

(7) Establish categories of advanced practice registered nurses in the roles of certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and clinical nurse specialist (CNS) and in the population foci of family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women's health/gender-related or psychiatric/mental health. Each APRN shall use the designation "APRN" plus role title as a minimum for purposes of identification and documentation. When providing nursing care, the APRN shall provide clear identification that indicates his or her APRN designation;

(8) Issue a temporary permit to practice nursing to applicants who apply for licensure by endorsement and to new graduates awaiting results of the first licensing examination;

(9) Conduct hearings upon charges calling for discipline of a licensee or revocation of a license;

(10) Have the power to issue subpoenas and compel the attendance of witnesses, and administer oaths to persons giving testimony at hearings;

(11) Cause the prosecution of all persons violating this chapter and have the power to incur such necessary expenses therefor;

(12) Keep a record of all its proceedings;

(13) Make an annual report to the Governor;

(14) Have all of the duties, powers and authority necessary to the enforcement of this chapter, as well as such other duties, powers and authority as it may be granted from time to time by appropriate statute;

(15) Appoint advisory committees as the Board deems desirable;

(16) Maintain a system of statistics related to nursing education programs and registered nurse and licensed practical nurse licensure in the State;

(17) Participate in and pay fees to the national organization of state boards of nursing, the National Council of State Boards of Nursing, Inc.;

(20) Have the authority to grant, restrict, suspend or revoke practice or prescriptive authority and be responsible for promulgating rules and regulations to implement the provisions of this chapter regarding advanced practice registered nurses who have been granted authority for independent practice or prescriptive authority;

(21) Have the authority to limit the ability of APRNs to prescribe and order nonpharmacological interventions.

(b) The Board of Nursing shall promulgate regulations specifically identifying those crimes which are substantially related to the practice of nursing.

(a) The Board shall meet as often as necessary to carry out its responsibilities as defined in this chapter.

(b) Special meetings of the Board may be called by the Executive Director upon the request of the President or any 2 members.

(c) The Board shall consider and act upon applications to conduct a nursing education program.

(d) The amount charged for each fee imposed under this chapter shall approximate and reasonably reflect all costs necessary to defray the expenses of the Board and the proportional expenses incurred by the Division of Professional Regulation in its services on behalf of the Board. There shall be a separate fee charged for each service or activity, but no fee shall be charged for a purpose not specified in this chapter. The application fee shall not be combined with any other fee or charge. At the beginning of each calendar year, the Division of Professional Regulation, or any other state agency acting on its behalf, shall compute for each separate service or activity the appropriate Board fees for the coming year.

No unlicensed person, except those persons issued a temporary permit by the Board, shall practice advanced practice, professional or practical nursing. Upon request, any person engaged in the practice of advanced practice, professional or practical nursing shall exhibit a license authorizing such practice.

An applicant for a license to practice as a registered nurse shall submit to the Board written evidence, verified by oath, that the applicant:

(1) Is a graduate of and holds a certificate from a State Board of Nursing approved nursing education program that is authorized to prepare persons for licensure as a registered nurse;

(2) Demonstrates competence in English related to nursing;

(3) Has earned a high school diploma or its equivalent;

(4) Is of such satisfactory physical and mental health as is consistent with the Americans with Disabilities Act [42 U.S.C. § 12101 et. seq.];

(5) Has committed no acts which are grounds for disciplinary action as set forth in § 1922(a) of this title; however, after a hearing or review of documentation demonstrating that the applicant meets the specified criteria for a waiver, the Board, by an affirmative vote of a majority of the quorum may waive § 1922(a)(2) of this title if it finds all of the following:

a. For waiver of a felony conviction, more than 5 years have elapsed since the date of the conviction. At the time of the application the applicant may not be incarcerated, on work release, on probation, on parole, or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution, and community service.

b. For waiver of a misdemeanor conviction or violation, at the time of the application the applicant may not be incarcerated, on work release, on probation, on parole, or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution, and community service.

c. The applicant is capable of practicing nursing in a competent and professional manner.

d. The granting of a waiver will not endanger the public health, safety, or welfare.

e. The applicant has not been convicted of a felony sexual offense;

(6) If seeking licensure by endorsement, demonstrates active employment in professional nursing in the past 5 years, or satisfactory completion of a professional nursing refresher program with an approved agency within 2 years prior to filing an application. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in professional nursing; and

(7) Has passed the standard national examination for registered nursing. The National Council of State Boards of Nursing shall establish the passing score.

(a) The Board may, by endorsement, without written examination, license as a registered nurse an applicant who, on or after July 1, 1983, is duly licensed as a registered nurse or is entitled to perform similar services under a different title under the laws of another state or territory of the United States or a foreign country if, in the opinion of the Board, the applicant meets the qualifications specified by this chapter for registered nurses in this State.

(b) In the event the applicant has not been actively employed in professional nursing in the past 5 years, the applicant will be required to give evidence of satisfactory completion of a professional nursing refresher program with an approved agency within 2 years prior to endorsement before licensure by endorsement will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in professional nursing.

(c) Verification of current Delaware license is provided upon request to other state boards of nursing.

(a) Any person holding a license to practice nursing as a registered nurse that is valid on July 1, 1983, shall be deemed to be licensed as a registered nurse under this chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by § 1918 of this title.

(b) Any person eligible for reactivation or reinstatement of a license to practice nursing as a registered nurse in this state on or after July 1, 1983, shall be deemed to be eligible to be licensed as a registered nurse under this chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by § 1918 of this title.

(c) Any person whose license to practice nursing as a registered nurse has lapsed in this State on or after July 1, 1983, because of failure to renew may become licensed as a registered nurse under this chapter by applying for reinstatement according to the rules and regulations established by the Board of Nursing.

(d) Any person who was licensed to practice nursing as a registered nurse and who had requested to be placed on inactive status in this State on or after July 1, 1983, may become licensed as a registered nurse under this chapter by applying for reactivation according to the rules and regulations established by the Board of Nursing.

An applicant for a license to practice as a licensed practical nurse shall submit to the Board written evidence, verified by oath, that such applicant:

(1) Is a graduate of and holds a certificate from a State Board of Nursing approved practical nursing education program. The Board may, by an affirmative vote of a majority of a quorum of the Board, waive this requirement for application for licensure by endorsement if it finds clear and convincing evidence that the applicant's education, training, experience, and conduct have been sufficient to overcome the deficiency in meeting this requirement;

(2) Demonstrates competence in English related to nursing;

(3) Has earned a high school diploma or its equivalent;

(4) Is of such satisfactory physical and mental health as is consistent with the Americans with Disabilities Act [42 U.S.C. § 12101 et. seq.];

(5) Has committed no acts which are grounds for disciplinary action as set forth in § 1922(a) of this title; however, after a hearing or review of documentation demonstrating that the applicant meets the specified criteria for a waiver, the Board, by an affirmative vote of a majority of the quorum may waive § 1922(a) of this title if it finds all of the following:

a. For waiver of a felony conviction, more than 5 years have elapsed since the date of the conviction. At the time of the application the applicant may not be incarcerated, on work release, on probation, on parole or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution, and community service.

b. For waiver of a misdemeanor conviction or violation, at the time of the application the applicant may not be incarcerated, on work release, on probation, on parole, or serving any part of a suspended sentence and must be in substantial compliance with all court orders pertaining to fines, restitution, and community service.

c. The applicant is capable of practicing nursing in a competent and professional manner.

d. The granting of a waiver will not endanger the public health, safety, or welfare.

e. The applicant has not been convicted of a felony sexual offense;

(6) If seeking licensure by endorsement, demonstrates active employment in practical nursing in the past 5 years, or satisfactory completion of a practical nursing refresher program with an approved agency within 2 years prior to filing an application. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in practical nursing; and

(7) Has passed the standard national examination for practical nursing. The National Council of State Boards of Nursing shall establish the passing score.

(a) The Board may, by endorsement, without written examination, license as a practical nurse an applicant who, on or after July 1, 1983, is duly licensed as a practical nurse or is entitled to perform similar services under a different title under the laws of another state or a territory of the United States or a foreign country, if in the opinion of the Board, the applicant meets the qualifications specified by this chapter for licensed practical nurses in this State.

(b) In the event the applicant has not been actively employed in practical nursing in the past 5 years, the applicant will be required to give evidence of satisfactory completion of a practical nursing refresher program within an approved agency within 2 years prior to endorsement before licensure by endorsement will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in practical nursing.

(c) Verification of current Delaware license is provided upon request to other state boards of nursing.

(a) Any person holding a license to practice nursing as a licensed practical nurse that is valid on July 1, 1983, shall be deemed to be licensed as a licensed practical nurse under this chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by § 1918 of this title.

(b) Any person eligible for reactivation or reinstatement of a license to practice nursing as a licensed practical nurse in this State on or after July 1, 1983, shall be deemed to be eligible to be licensed as a licensed practical nurse under this chapter and shall be eligible for renewal of such license under the conditions and standards prescribed by § 1918 of this title.

(c) Any person whose license to practice nursing as a licensed practical nurse has lapsed in this State on or after July 1, 1983, because of failure to renew may become licensed as a licensed practical nurse under this chapter by applying for reinstatement according to the rules and regulations established by the Board of Nursing.

(d) Any person who was licensed to practice nursing as a licensed practical nurse and who had requested to be placed on inactive status in this State on July 1, 1983, may become licensed as a licensed practical nurse under this chapter by applying for reactivation according to the rules and regulations established by the Board of Nursing.

(a) Every advanced practice registered nurse or registered or licensed practical nurse licensed under this chapter shall reregister biennially by filing an application; provided however, that the license of any licensee who is on active military duty with the armed forces of the United States and serving in a theater of hostilities on the date such application or reregistration is due shall be deemed to be current and in full compliance with this chapter until the expiration of 60 days after such licensee is no longer on active military duty in a theater of hostilities. The advanced practice registered nurses' licensure or prescriptive authority is subject to biennial renewal coinciding with RN license renewal. In the event the applicant has not been actively employed in professional, practical, or advanced practice registered nursing in the past 5 years, the applicant must provide evidence of satisfactory completion of an appropriate Board -approved nursing advanced practice refresher program within 1 year before licensure by reinstatement.

APRNs who have been out of active clinical practice more than 2 years but less than 5 years must submit 24 hours of CE with 12 hours in pharmacotherapeutics and 12 hours in the clinical management of patients taken within 1 year before application. APRNs who have been out of active clinical practice more than 5 years must submit 45 hours of pharmacotherapeutics CE taken within 1 year before application and the advanced practice refresher program. In the event no advanced practice refresher program is available, the applicant must complete 600 hours of supervised clinical experience in the appropriate advanced practice role and population focus, with a qualified preceptor within 1 year before licensure by reinstatement. A qualified APRN preceptor must hold an active unencumbered license or privilege to practice as an APRN or be a physician who has an active unencumbered license and practices in a comparable practice focus in the clinical setting.

(b) Upon receipt of the application and fee, the Board shall verify the accuracy of the information set forth in the application and issue to the applicant a certificate of renewal of license for 2 years, provided that the applicant has successfully completed continuing education requirements as may be established by the Board. Such certificate shall entitle the holder to engage in the practice of professional, practical, or advanced practice registered nursing for the period stated therein. Any licensee whose license lapses for failure to renew the license may be reinstated by the Board upon satisfactory evidence of active employment in professional, practical, or advanced practice registered nursing within the past 5 years or satisfactory completion of a refresher program within an approved agency within a 1-year period prior to renewal and upon satisfactory explanation for the failure to renew the license and payment of a penalty fee to be determined.

(c) A license may be renewed up to 60 days past the license's expiration date, by submitting to the Division of Professional Regulation payment of the penalty fee referred to in subsection (b) of this section and proof of completion of continuing education requirements. The license of a nurse who fails to renew on time is considered lapsed and the nurse is not permitted to work until the license is renewed. Licensees who fail to renew during the renewal period or during the 60-day late renewal period must apply for reinstatement.

(d) After a license has lapsed or been inactive for 5 or more years and the applicant has not been in active practice in professional or practical nursing in the past 5 years, the applicant will be required to give evidence of satisfactory completion of a professional or practical nursing refresher program within an approved agency within 1 year prior to reinstatement before licensure by reinstatement will be granted. In the event no refresher course is available the Board may consider alternate methods of evaluating current knowledge in professional or practical nursing.

(e) Any person practicing nursing during the time that person's license has lapsed shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of this chapter.

(f) Any person licensed under this chapter who desires to retire from practice in this State shall so notify the Board. Upon receipt of such notice, the Board shall place the name of such person on a nonpracticing list. While on this list, such person shall not be required to pay any license fee, and shall not practice nursing in this State. When such person desires to resume practice, application for renewal shall be made under subsection (a) of this section and the license shall be reactivated if the requirements of the Board are met.

(g) Temporary permits to practice nursing may be issued by the Board to persons who have requested reinstatement of their license, if they have practiced nursing within the past 5 years.

(h) Every registered or licensed practical nurse licensed under this chapter primarily engaged in the practice of electrolysis shall be exempt from the requirement in subsection (a) of this section that states in the event the applicant has not been actively employed in professional practical nursing in the past 5 years, the applicant will be required to give evidence of satisfactory completion of a professional or practical nursing refresher program within 2 years prior to renewal before licensure by renewal will be granted.

(i) An individual licensed under this chapter may, upon written request to the Board, be placed in an inactive status in accordance with the Board's rules and regulations. An individual may reenter practice from inactive status if the individual provides written notification to the Board of the individual's intent and complies with any relevant provisions of this chapter and the Board's regulations.

(a) An institution desiring to conduct a nursing education program shall apply to the Board and submit satisfactory evidence that it is ready and qualified to instruct students in the prescribed basic curriculum for educating nurses and that it is prepared to meet other standards which may be established by the Board. The Board may authorize the temporary operation of a nursing education program pending evaluation for approval. The Board shall grant approval in writing. The Board may visit and survey any nursing education program at any reasonable time.

(b) If the Board determines that any approved nursing education program is not maintaining the standards required by this chapter and by the Board, written notice thereof, specifying the deficiency and the time within which the same shall be corrected, shall immediately be given to the program. The Board shall withdraw such program's approval if it fails to correct the specified deficiency, and such nursing education program shall discontinue its operation; provided, however, that the Board shall grant a hearing to such program upon written application and extend the period for correcting specified deficiency upon good cause being shown.

(c) An approved nursing education program which plans substantive changes, as defined in the Board's rules and regulations, shall obtain the written approval of the Board prior to the date of the change.

(d) Any nursing education program in the State that is recognized as an approved program by the Board of Nursing on or after July 1, 1983, shall be deemed to be an approved education program for the purpose of this chapter.

(a) No person shall engage in the practice of professional nursing in Delaware without being licensed by the Board, except those persons issued a temporary permit by the Board.

(b) No person shall engage in practice as an advanced practice registered nurse without a board-issued license as an advanced practice registered nurse. Notwithstanding any provision to the contrary, the use of title and abbreviation for advanced practice registered nurses is authorized in accordance with the following:

(1) Only certified registered nurse anesthetists may use that title, the abbreviation "CRNA" or any other words, letters, signs or figures indicating that the person using the same is a certified registered nurse anesthetist.

(2) Only certified nurse practitioners may use that title, the abbreviation "CNP" or any other words, letters, signs or figures indicating that the person using the same is a certified nurse practitioner.

(3) Only certified nurse midwives may use that title, the abbreviation "CNM" or any other words, letters, signs or figures indicating that the person using the same is a certified nurse midwife.

(4) Only clinical nurse specialists may use that title, the abbreviation "CNS" or any other words, letters, signs or figures indicating that the person using the same is a clinical nurse specialist.

(5) The abbreviation for the "APRN" designation for a certified nurse practitioner, a certified registered nurse anesthetist, a certified nurse midwife, and for a clinical nurse specialist will be "APRN," plus the role title, i.e., "CNP," "CRNA," "CNM," or "CNS." It shall be unlawful for any person to use the title "APRN" or "APRN" plus their respective role titles, authorized abbreviations or any other title that would lead a person to believe the individual is an APRN, unless permitted by this chapter.

(c) No person shall knowingly employ a graduate of a professional nursing program or a registered nurse to engage in the practice of professional nursing without a temporary permit or license from the Board.

(d) Only registered nurses shall use that title, the title "nurse", the abbreviation of "R.N." or any other words, letters, signs or figures indicating that the person using the same is a registered nurse.

(e) No person shall practice practical nursing in Delaware without being licensed by the Board, except those persons issued a temporary permit by the Board.

(f) No person shall knowingly employ a graduate of a practical nursing program or a licensed practical nurse to engage in the practice of practical nursing without a temporary permit or license from the Board.

(g) Only licensed practical nurses shall use that title, the title "nurse", the abbreviation "L.P.N." or any other words, letters, signs or figures indicating that the person using the same is a licensed practical nurse.

(1) Nursing services rendered during an epidemic or a state or national disaster;

(2) The rendering of assistance by anyone in the case of an emergency;

(3) Emergency services rendered by ambulance personnel trained in advanced life support under a licensed physician's supervision as defined in Chapter 97 of Title 16. "Advanced life support" is defined in Chapter 97 of Title 16;

(4) The incidental care of the sick in private homes by members of the family, friends, domestic servants or persons primarily employed as housekeepers;

(5) Nursing services rendered by a student enrolled in a State Board of Nursing approved school of professional or practical nursing when these services are incidental to the course of study; or those nursing services rendered by a professional nurse or practical nurse enrolled in a State Board of Nursing approved refresher course pending reinstatement, reactivation or endorsement of licensure;

(6) The practice of nursing in this State by a nurse licensed in another state whose employment requires such nurse to accompany and care for a patient temporarily in this State, provided the nursing services are not rendered for more than 3 months within 1 year and such nurse does not claim to be licensed in this State;

(7) The practice of nursing by a nurse licensed in another state employed by the United States government or any bureau, division or agency thereof;

(8) The practice of nonmedical nursing in connection with healing by prayer or spiritual means in accordance with the tenets and practice of a well-recognized church or religious denomination, provided that persons practicing such nonmedical nursing do not claim to be licensed under this chapter;

(9) Auxiliary care services performed by nurse's aides, attendants, orderlies and other auxiliary workers in medical care facilities, or elsewhere by persons under the direction and supervision of a person licensed to practice nursing, medicine, dentistry or podiatry, and performing those services which are routine, repetitive and limited in scope, and that do not require the professional judgment of a registered nurse or a licensed practical nurse; provided, however, that nothing contained herein shall limit the right of any person to act pursuant to [former] § 1703(e)(7) of this title [repealed], or persons employed in similar positions in the offices of podiatrists or dentists without being licensed under this chapter;

(10) Administration of prescription or nonprescription medications, other than by injection, by child care providers who have successfully completed a state-approved medication training program, to children in child day care homes or child day care centers regulated by the State under §§ 341-344 of Title 31; provided the medication and written permission for the administration of the particular medication has been obtained from the child's parent or legal guardian and further provided the medication is in its original container, properly labeled. Properly labeled medication shall include instructions for administration of the medication;

(11) Nursing services rendered by a graduate of a State Board of Nursing approved school of professional or practical nursing working under supervision, pending results of the first licensing examination. The Board shall establish the procedure and extent to which subsequent examinations may be taken and the length of time and the character of nursing service which may be rendered pending subsequent examinations;

(12) The practice of any currently licensed registered nurse or licensed practical nurse of another state who provides or attends educational programs or provides consultative services within this State not to exceed 14 days in any calendar year. Neither the education nor consultation may include the provision of patient care, the direction of patient care or the affecting of patient care policies.

(13) Educators, coaches, or persons hired or contracted by schools serving students in kindergarten through grade 12 who assist students with medications that are self-administered during school field trips and approved school activities outside the traditional school day or off-campus that have completed a Board of Nursing approved training course developed by the Delaware Department of Education;

(14) Attendants providing basic and ancillary services defined and regulated by the Department of Health and Social Services in conformity with the Community-Based Attendant Services Act, Chapter 94 of Title 16;

(15) A competent individual who does not reside in a medical facility or a facility regulated pursuant to Chapter 11 of Title 16, may delegate to unlicensed persons performance of health-care acts, unless of a nature excluded by the Board through regulations, provided:

a. The acts are those individuals could normally perform themselves but for functional limitations; and

(16) The limited lay administration of medications pursuant to § 1932 of this title.

(b) Persons involved in the rendering of electrolysis treatments shall be eligible for licensing under this chapter regardless of whether the applicant is in compliance with § 1910(6) of this title, or § 1914(6) of this title, so long as such applicants are in compliance with either § 1910(1)-(5) or § 1914(1)-(5) of this title.

(a) Grounds. — The Board may impose any of the following sanctions (subsection (b) of this section) singly or in combination when it finds a licensee or former licensee is guilty of any offense described herein, except that the license of any licensee who is convicted of a felony sexual offense shall be permanently revoked:

(1) Is guilty of fraud or deceit in procuring or attempting to procure a license to practice nursing; or

(2) Has been convicted of a crime that is substantially related to the practice of nursing; or

(3) Is unfit or incompetent by reason of negligence, habits, or other causes; or

(4) Is habitually intemperate or is addicted to the use of habit-forming drugs; or

(5) Is mentally incompetent; or

(6) Has a physical condition such that the performance of nursing service is or may be injurious or prejudicial to patients or to the public; or

(7) Has had a license to practice as a registered nurse or licensed practical nurse suspended or revoked in any jurisdiction; or

(8) Is guilty of unprofessional conduct or the wilful neglect of a patient; or

(9) Has wilfully or negligently violated this chapter; or

(10) Has failed to report child abuse or neglect as required by § 903 of Title 16, or any successor thereto; or

(11) Has failed to report to the Division of Professional Regulation as required by §§ 1930 and 1930A of this title.

(b) Disciplinary sanctions. —

(1) Permanently revoke a license to practice.

(2) Suspend a license.

(3) Censure a licensee.

(4) Issue a letter of reprimand.

(5) Place a licensee on probationary status and require the licensee to do 1 or more of the following :

a. Report regularly to the Board upon the matters which are the basis of probation.

b. Limit practice to those areas prescribed by the Board.

c. Continue or renew professional education until satisfactory degree of skill has been attained in those areas which are the basis of the probation.

(6) Refuse a license.

(7) Refuse to renew a license.

(8) Impose a monetary penalty not to exceed $500 for each violation.

(9) Take any other disciplinary action.

(c) Procedure. —

(1) When a complaint is filed pursuant to § 8735 of Title 29, alleging a violation of this chapter, the complaint shall be received and investigated by the Division of Professional Regulation and the Division shall be responsible for issuing a final written report at the conclusion of its investigation.

(2) The Board shall cause a copy of the complaint, together with a notice of the time and place fixed for the hearing, to be served upon the practitioner at least 30 days before the date fixed for the hearing. In cases where the practitioner cannot be located or where personal service cannot be effected, substitute service shall be effected in the same manner as with civil litigation.

(3) In all proceedings under this chapter:

a. The accused may be represented by counsel who shall have the right of examination and cross-examination.

b. The accused and the Board may subpoena witnesses. Subpoenas shall be issued by the President or the Vice-President of the Board upon written request and shall be served as provided by the rules of the Superior Court and shall have like effect as a subpoena issued by said Court.

c. Testimony before the Board shall be under oath. Any member of the Board shall have power to administer oaths for this purpose.

d. A stenographic record of the hearing shall be made by a qualified court reporter. At the request and expense of any party such record shall be transcribed with a copy to the other party.

e. The decision of the Board shall be based upon sufficient legal evidence. If the charges are supported by such evidence, the Board may refuse to issue, or revoke or suspend a license, or otherwise discipline a licensee. A suspended license may be reissued upon a further hearing initiated at the request of the suspended licensee by written application in accordance with the rules of the Board.

f. All decisions of the Board shall be final and conclusive. Where the practitioner is in disagreement with the action of the Board, the practitioner may appeal the Board's decision to the Superior Court within 30 days of service or of the postmarked date of the copy of the decision mailed to the practitioner. The appeal shall be on the record to the Superior Court and shall be as provided in §§ 10142-10145 of Title 29.

g. Upon reaching its conclusion of law and determining an appropriate disciplinary action, if any, the Board shall issue a written decision and order in accordance with § 10128 of Title 29. The order must restate the factual findings, but need not summarize the evidence presented. However, notwithstanding the provisions of § 10128(c) of Title 29, the decision and order, including an order issued pursuant to § 1923 of this title, may be issued over the signature of only the President or other officer of the Board. The decision and order must be sent by certified mail, return receipt requested, to the person complained about, with a copy to the Executive Director.

In the event of a formal or informal complaint concerning the activity of a licensee that presents a clear and immediate danger to the public health, safety or welfare, the Board may temporarily suspend the person's license, pending a hearing, upon the written order of the Secretary of State or the Secretary's designee, with the concurrence of the Board chair or the Board chair's designee. An order temporarily suspending a license may not be issued unless the person or the person's attorney received at least 24 hours' written or oral notice before the temporary suspension so that the person or the person's attorney may file a written response to the proposed suspension. The decision as to whether to issue the temporary order of suspension will be decided on the written submissions. An order of temporary suspension pending a hearing may remain in effect for no longer than 60 days from the date of the issuance of the order unless the temporarily suspended person requests a continuance of the hearing date. If the temporarily suspended person requests a continuance, the order of temporary suspension remains in effect until the hearing is convened and a decision is rendered by the Board. A person whose license has been temporarily suspended pursuant to this section may request an expedited hearing. The Board shall schedule the hearing on an expedited basis, provided that the Board receives the request within 5 calendar days from the date on which the person received notification of the decision to temporarily suspend the person's license.

(a) No person shall practice or offer to practice professional or practical nursing or shall represent himself or herself as a registered nurse or licensed practical nurse in this State, or shall use any title, abbreviation, sign, card or device to indicate that such person is a registered nurse or licensed practical nurse, unless such person is licensed under this chapter.

(b) No person, hospital or institution shall conduct or shall offer to conduct a professional or practical nursing education program unless such person, hospital or institution is approved under this chapter.

(1) Sell or fraudulently obtain or furnish any nursing diploma, license or renewal, or record of the same, or aid or abet therein; or

(2) Practice professional or practical nursing and/or hold or represent himself or herself as a registered or licensed practical nurse under cover of any diploma, license or record illegally or fraudulently obtained, signed or issued; or

(3) Practice professional or practical nursing unless licensed under this chapter; or

(4) Use, in connection with that person's name any designation tending to imply that the person is a registered or practical nurse, unless licensed under this chapter; or

(5) Practice professional or practical nursing when that person's license is suspended or revoked; or

(6) Conduct a professional or practical nursing education program which has not been approved by the Board; or

(7) Knowingly employ a graduate of a professional or practical nursing program or a registered nurse or a practical nurse to engage in the practice of nursing without a valid temporary permit or license from the Board; or

(8) Violate standards of nursing practice as adopted by the Board;

shall be fined not more than $1,000, or be imprisoned not more than 1 year, or both.

Each member of the Board of Nursing on July 1, 1983, becomes a member of the Board created by this chapter until the expiration of the term which that member was serving on that date. Any vacancy occurring in the membership of the former Board shall be filled in the manner provided in this chapter.

An APRN licensed by the Board may prescribe, order, procure, administer, store, dispense and furnish over the counter, legend and controlled substances pursuant to applicable state and federal laws and within the APRN's role and population focus.

(1) Written, verbal or electronic prescriptions and orders shall comply with all applicable state and federal laws.

(2) All prescriptions shall be clearly written, clearly hand-printed, electronically printed, or typed and shall include, but not be limited to, the following information:

a. The name, title, address, phone number, and registration number of the prescriber;

b. Name of patient;

c. Date of prescription;

d. Full name of the drug, dosage, route, amount to be dispensed and directions for its use;

e. Number of refills;

f. Signature of prescriber on written prescription;

g. DEA number of the prescriber on all scheduled drugs.

(3) APRNs may receive, sign for, record and distribute samples to patients. Distribution of drug samples shall be in accordance with state law and federal Drug Enforcement Administration laws, regulations and guidelines.

An applicant for licensure to practice as a registered nurse shall submit, at the applicant's expense, fingerprints and other necessary information in order to obtain the following:

(1) A report of the individual's entire criminal history record from the State Bureau of Identification or a statement from the State Bureau of Identification that the State Central Repository contains no such information relating to that person.

(2) A report of the individual's entire federal criminal history record pursuant to the Federal Bureau of Investigation appropriation of Title II of Public Law 92-544 (28 U.S.C. § 534). The State Bureau of Identification shall be the intermediary for purposes of this section and the Board of Nursing shall be the screening point for the receipt of said federal criminal history records.

An applicant for licensure to practice as a licensed practical nurse shall submit, at the applicant's expense, fingerprints and other necessary information in order to obtain the following:

(1) A report of the individual's entire criminal history record from the State Bureau of Identification or a statement from the State Bureau of Identification that the State Central Repository contains no such information relating to that person.

(2) A report of the individual's entire federal criminal history record pursuant to the Federal Bureau of Investigation appropriation of Title II of Public Law 92-544 (28 U.S.C. § 534). The State Bureau of Identification shall be the intermediary for purposes of this section and the Board of Nursing shall be the screening point for the receipt of said federal criminal history records.

§ 1930 Duty to report conduct that constitutes grounds for discipline or inability to practice.

(a) Every person to whom a license to practice has been issued under this chapter has a duty to report to the Division of Professional Regulation in writing information that the licensee reasonably believes indicates that any other practitioner licensed under this chapter or any other healthcare provider has engaged in or is engaging in conduct that would constitute grounds for disciplinary action under this chapter or the other healthcare provider's licensing statute.

(b) Every person to whom a license to practice has been issued under this chapter has a duty to report to the Division of Professional Regulation in writing information that the licensee reasonably believes indicates that any other practitioner licensed under this chapter or any other healthcare provider may be unable to practice with reasonable skill and safety to the public by reason of: mental illness or mental incompetence; physical illness, including deterioration through the aging process or loss of motor skill; or excessive abuse of drugs, including alcohol.

(c) Every person to whom a license to practice has been issued under this chapter has a duty to report to the Division of Professional Regulation any information that the reporting person reasonably believes indicates that a person certified and registered to practice medicine in this State is or may be guilty of unprofessional conduct or may be unable to practice medicine with reasonable skill or safety to patients by reason of: mental illness or mental incompetence; physical illness, including deterioration through the aging process or loss of motor skill; or excessive use or abuse of drugs, including alcohol.

(d) All reports required under subsections (a), (b) and (c) of this section must be filed within 30 days of becoming aware of such information. A person reporting or testifying in any proceeding as a result of making a report pursuant to this section is immune from claim, suit, liability, damages, or any other recourse, civil or criminal, so long as the person acted in good faith and without gross or wanton negligence; good faith being presumed until proven otherwise, and gross or wanton negligence required to be shown by the complainant.

(1) Any arrest for, or the bringing of an indictment or information charging the licensee with, a crime substantially related to the practice of nursing as defined by the Board in its rules and regulations.

(2) The conviction of the licensee, including any verdict of guilty or plea of guilty or no contest, for any crime substantially related to the practice of nursing as defined by the Board in its rules and regulations.

(b) The report required by this section must be made in writing within 30 days of the date of the arrest, bringing of the indictment or information, or of the conviction.

(c) Failure to make a report required by this section constitutes grounds for discipline under § 1922 of this title.

(a) A parent, guardian or other caretaker, or an adult staff member, shall be present when a person licensed under this chapter provides outpatient treatment to a minor patient who is disrobed or partially disrobed or during an outpatient physical examination involving the breasts, genitalia or rectum, regardless of sex of the licensed person and patient, except when rendering care during an emergency. When using an adult staff member to observe the treatment or examination, the adult staff member shall be of the same gender as the patient when practicable. The minor patient may decline the presence of a third person only with consent of a parent, guardian or other caretaker. The minor patient may request private consultation with the licensee without the presence of a third person after the physical examination.

(b) When a minor patient is to be disrobed, partially disrobed or will undergo a physical examination involving the breasts, genitalia or rectum, a person licensed under this chapter shall provide notice to the person providing consent to treatment of the rights under this section. The notice shall be provided in written form or be conspicuously posted in a manner in which minor patients and their parent, guardian or other caretaker are made aware of the notice. In circumstances in which the posting or the provision of the written notice would not convey the right to have a chaperone present, the person licensed shall use another means to ensure that the person understands the right under this section.

(c) For the purposes of this section, "minor" is defined as a person 15 years of age or younger, and "adult staff member" is defined as a person 18 years of age or older who is acting under the direction of the licensed person or the employer of the licensed person or who is otherwise licensed under this chapter.

(d) The person licensed under this chapter that provides outpatient treatment to a minor pursuant to this section shall, contemporaneously with such treatment, note in the child's medical record the name of each person present when such treatment is being provided.

(a) Individuals who have successfully completed a board-approved limited lay administration of medications training program may administer prescription or nonprescription medications to patients/residents/clients in the following settings:

(1) Residential child care facilities and day treatment programs regulated by the State under Title 31.

(2) All residential or day services for persons with intellectual disabilities regulated by the State under Chapter 79 of Title 29 and Chapter 11 of Title 16.

(3) Group homes for persons with psychiatric disabilities regulated by the State under Chapter 11 of Title 16 and other community support programs certified by the Division of Substance Abuse and Mental Health.

(4) Assisted living facilities regulated by the State under Chapter 11 of Title 16.

(5) Group homes established for persons with AIDS regulated by the State under Chapter 11 of Title 16.

(b) Medications must be in the original container and properly labeled.

(c) An annual report to the Board of Nursing, on a form developed by the Board of Nursing, must be submitted no later than August 1 of each year indicating compliance with the guidelines as set forth in the approved LLAM training program.

(a) Telemedicine shall not be utilized by an advanced practice registered nurse (APRN) with respect to any patient in the absence of an APRN-patient relationship.

(b) APRNs who utilize telemedicine shall, if such action would otherwise be required in the provision of the same service not delivered via telemedicine, ensure that a proper APRN-patient relationship is established which includes but is not limited to:

(1) Fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient;

(2) Disclosing and validating the provider's identity and applicable credential or credentials;

(3) Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including informed consents regarding the use of telemedicine technologies as indicated in paragraph (b)(5) of this section;

(4) Establishing a diagnosis through the use of acceptable medical practices, as patient history, mental status examination, physical examination (unless not warranted by the patient's mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identify underlying conditions or contra-indications, or both, to treatment recommended or provided;

(5) Discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options;

(6) Ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care; and

(7) Providing a written visit summary to the patient.

(c) Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.

(d) The APRN treating a patient through telemedicine must maintain a complete record of the patient's care which must follow all applicable state and federal statutes and regulations for recordkeeping, confidentiality, and disclosure to the patient.

(e) Telemedicine shall include, at such time as feasible and when appropriate, utilizing the Delaware Health Information Network (DHIN) in connection with the practice.

(f) Without a prior and proper patient-provider relationship, as provided in paragraph (b)(5) of this section, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

(g) Prescriptions made through telemedicine and under an APRN-patient relationship may include controlled substances, subject to limitations as set by the Board.

(h) This section does not apply to any of the following:

(1) Informal consultation performed by a APRN outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;

(2) Furnishing of medical assistance by a APRN in case of an emergency or disaster if no charge is made for the medical assistance;

(3) Episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a person licensed in this State.

(1) Four advanced practice registered nurses representing each category of APRN role with a variety of population foci, appointed by the Board of Nursing. Each APRN member of the Committee shall have at least the equivalent of 3 years of full-time experience in their APRN role.

(2) One pharmacist, appointed by the Board of Pharmacy.

(3) Four physicians who work with APRNs, appointed by the Board of Medical Licensure and Discipline.

(4) The first Committee Chair shall be 1 of the 2 APRNs who are members of the Board of Nursing and shall serve for 1 year, not to succeed himself or herself for more than 2 consecutive terms. The position of committee chair shall then rotate among Committee members.

(c) Appointments shall be for 3-year terms, provided that the terms of newly-appointed members will be staggered so that no more than 5 appointments shall expire annually. Members may be appointed for less than 3 years to ensure that members' terms expire on a staggered basis.

(d) A majority of members appointed to the Committee shall constitute a quorum to conduct official business.

(e) A Committee member may be removed at any time for gross inefficiency, neglect of duty, malfeasance, misfeasance, or nonfeasance in office. A member who is absent from 3 consecutive committee meetings without good cause or who attends less than 50% of committee meetings in a calendar year shall be deemed in neglect of duty.

(f) The Committee shall:

(1) Draft rules and regulations regarding competencies, benchmarks, and metrics within each of the 4 roles and 6 population foci that must be accomplished during the collaborative agreement period for review by the Board.

(2) Review emerging practices and advise the Board of Nursing on APRN licensure and practice standards, including prescribing trends and provide recommendations to the Board of Nursing regarding APRN practice.

(3)a. Make recommendations to the Board of Nursing whether to grant or deny requests for independent practice. The Committee may also recommend that individual collaborative agreement periods be extended for additional time.

b. The Committee shall make its recommendation after evaluating evidence that a graduate advanced practice registered nurse or APRN has:

1. Practiced under a collaborative agreement within a hospital or integrated clinical setting for at least 2 years and a minimum of 4,000 full-time hours. The physician, podiatrist, or health-care delivery system party to the collaborative agreement must practice in an area substantially related to the population and focus of the APRN's education, certification, and planned independent practice. The 2-year collaboration will not commence until the collaborative agreement is submitted to the Committee and Board of Nursing.

2. Submitted written evidence that the collaborators have satisfactorily completed 2 years and a minimum of 4,000 full-time hours of collaboration in compliance with the Board of Nursing's rules and regulations regarding competencies, benchmarks, and metrics within the APRN's role and population focus. Such written evidence shall be submitted after the completion of the practice hours required in this chapter and prior to the granting of independent practice.

(4)a. The Board of Nursing shall provide to the Board of Medical Licensure and Discipline a monthly list of APRNs who were granted prescriptive authority.

b. When an APRN who has been granted independent practice comes before the Board of Nursing for discipline related to a deviation from the standard of care, the Board of Nursing's decision must be approved by the Board of Medical Licensure and Discipline.

(a)(1) The Board of Nursing grants full-practice and prescriptive authority upon the issuance of an APRN license. The granting of full-practice authority does not equate to the granting of independent practice.

(2) The Board may, by endorsement, license as an advanced practice registered nurse an applicant who is duly licensed as an advanced practice registered nurse or is entitled to perform similar services under a different title under the laws of another state or a territory of the United States or a foreign country if, in the opinion of the Board, the applicant meets the qualifications specified by its regulations for advanced practice registered nurses in this State.

(b) An APRN licensed by the Board of Nursing with full-practice authority is authorized within the APRN's role and population foci to:

(1) Prescribe, procure, administer, store, dispense, and furnish over the counter, legend and controlled substances pursuant to applicable state and federal laws and within the APRN's role and population foci.

(2) Plan and initiate a therapeutic regimen within the APRN's role and population foci that includes ordering and prescribing nonpharmacological interventions, including:

(a) A collaborative agreement must outline how the parties to the agreement will cooperate, coordinate, and consult pursuant to the Board of Nursing's rules and regulations.

(b) All new APRN graduates and those nurses seeking to obtain independent practice must practice under a collaborative agreement for 2 years and a minimum of 4,000 full-time hours.

(c) An APRN already practicing under a collaborative agreement as of July 1, 2015, who seeks to obtain independent practice must resubmit the collaborative agreement to the APRN Committee in order to be granted credit for any hours accumulated and must otherwise comply with the relevant provisions of this chapter and the Board's regulations.